Doctors treated prehypertension with medication, drug company says

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ATLANTA — Treating people who don’t yet have high blood pressure but are well on their way to it can delay the condition but not permanently prevent it unless drugs are taken lifelong, new research suggests.

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It is the first extensive study of treating prehypertension, a condition 45 million Americans have, defined as blood pressure readings from 120 over 80 up to 139 over 89. Below that is considered normal and above it, high.

High blood pressure greatly raises the risk of heart failure, stroke, heart attacks and other medical problems. Doctors had hoped that two years of early treatment could permanently halt the progression from prehypertension to that more dangerous state.

The study suggests they may not have started early enough.

“We may need to rethink what we consider a normal blood pressure,” said Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute.

Dr. Stevo Julius of the University of Michigan in Ann Arbor and doctors at 70 other sites around the country tested treating prehypertension with candesartan, a drug sold as Atacand by AstraZeneca PLC. The company sponsored and helped design the study.

Researchers gave 391 people the drug and 381 others phony pills for two years, then had everyone take dummy pills for two more years.

During the first two years, 154 people on fake pills developed high blood pressure versus only 53 given the drug.

However, in the next two years when those on the drug went off, 155 developed high blood pressure, matching what happened in the first two years in the placebo group.

This suggests the disease was just delayed, not truly prevented, said Dr. James Stein, a University of Wisconsin-Madison cardiologist who had no role in the research.

“Once people stop therapy, blood pressure goes up inexorably, so I’m not sure we can prevent hypertension,” he said.

Results were presented Tuesday at an American College of Cardiology meeting and published online by the New England Journal of Medicine.

Although the study was paid for by a drug company, it is “very important” and will be strongly considered when federal guidelines are next reviewed, Nabel said. Guidelines now advise starting treatment when the “big number” hits 140, but study participants who had “high normal” readings averaging 134 were too far down the road to derail the disease, she said.

The study also supports the growing realization that “high” blood pressure is a continuum rather than an arbitrary threshold, said Dr. Tom Giles, president of the American Society of Hypertension.

“You can’t just look at the number. The disease process is in place before the blood pressure actually goes up at all,” he said.

Blood pressure also generally rises with age. Julius said study participants were relatively young, average age 48, “but I wish they had been much younger than that” because they appeared to need treatment sooner.

Specialists said that lifestyle changes like limiting salt and water and eating right remain cornerstones of controlling blood pressure.

“That’s what I did,” said Stein, who at age 33 had blood pressure of 135 over 90 and considered drug treatment.

“Instead, I lost 40 pounds, started eating fruits and vegetables. Now I’m at 118.”